| Objective:To explore the application value of carbon nanoparticles in the study of the rule of lymph node metastasis in the VIA and VIB regions of papillary thyroid carcinoma and the risk factors of lymph node metastasis in the VIA and VIB regions of papillary thyroid carcinoma,and to guide the dissection of lymph nodes in the central subregions of papillary thyroid carcinoma patients.Methods:From November,2018 to October,2019,175 cases of right-lobe or double-lobe papillary thyroid cancer patients were treated in the thyroid surgery department of China-Japan Union Hospital of Jilin University.The application of carbon nanoparticles was routinely introduced to the patients,and the application of carbon nanoparticles was decided according to the patients’ wishes.61 patients were treated with carbon nanoparticles(experimental group),and 114 patients were not treated with carbon nanoparticles(conventional group).The two groups of patients were compared to analyze the advantages of carbon nanoparticles in lymph node dissection.Meanwhile,all the data of 175 cases of lymph node metastasis were collected,and the regularity and risk factors of lymph node metastasis in the VIA and VIB regions were statistically analyzed.Results:(1)There was no statistically significant difference in the clinicopathological characteristics between the carbon nanoparticles group and the conventional group.The rate of lymph node metastasis in the VIA region was 54.86% and that in the VIB region was 28%.Among the patients with lymph node metastasis in the VIA region,the rate of lymph node metastasis in the VIB region was 45.8% and that in the patients with negative lymph node metastasis in the VIA region was only 6.3%.(2)In the low-risk group,the number of lymph nodes detected in the VIA region of the experimental group was higher than that in the conventional group(6.29±3.42 vs.4.71±2.68,P < 0.05),and the difference was statistically significant.However,in the low-risk group,there was no statistical difference in the number of lymph nodes detected in the VIB region between the experimental group and the conventional group.There was no significant difference in the number of lymph nodes detected between the experimental group and the routine group in the middle and high risk groups.In addition,there was no significant difference in the positive rate of VIA and VIB lymph node dissection between the experimental group and the conventional group in the low-risk group and the medium-risk group.(3)For patients with lymphocytic thyroiditis,no difference was found between the nanocarbon group and the control group,regardless of the total number of lymph nodes detected or the positive rate of lymph node dissection(P >0.05).(4)Univariate analysis showed that age < 45 years old,male,maximum diameter of tumor ≥1cm,capsule invasion,extra-glandular invasion,nodular calcification,and lymph node metastasis in the lateral cervical region were significantly correlated with lymph node metastasis in the VIA region of papillary thyroid carcinoma.Age < 45 years old,lymph node metastasis in the lateral cervical region and lymph node metastasis in the VIA region were significantly correlated with lymph node metastasis in the VIB region of papillary thyroid carcinoma.(5)Multivariate analysis showed that age < 45 and male were independent risk factors for lymph node metastasis in VIA region(P < 0.05).Lymph node metastasis with VIA region was an independent risk factor for lymph node metastasis in VIB region(P < 0.01).(6)ROC curve results of the influence of age on lymph node metastasis in VIA and VIB region showed that when age was 61.5 years old,AUC=0.324 < 0.7,sensitivity and specificity were 0.021 and 1,respectively,P=0.000 < 0.05,which was statistically significant,but did not have good diagnostic efficacy.When the age was 56.5 years,AUC=0.301 < 0.7,the sensitivity and specificity were 0.061 and 0.960,respectively,and P=0.000 < 0.05,which were statistically significant,but did not have good diagnostic efficacy.(7)The ROC curve results of the effect of the maximum diameter of the tumor on lymph node metastasis in the VIA region showed that when the maximum diameter of the tumor was 1.05 cm,AUC=0.705,the sensitivity and specificity were 0.563 and 0.797,respectively,P=0.000 < 0.05.It has statistical significance and good diagnostic efficiency.The ROC curve results of the effect of the maximum diameter of the tumor on lymph node metastasis in the VIA and VIB regions showed that when the maximum diameter of the tumor was 1.05 cm,the AUC was 0.644 < 0.7,and the sensitivity and specificity were 0.551 and 0.659,respectively,P=0.003 < 0.05.Even though it has statistical significance,it does not have good diagnostic efficacy.(8)The ROC curve of the influence of the number of lymph node metastases and the diameter of the metastases in the VIA region on the lymph node metastases in the VIB region showed that when the area VIA metastasis lymph node number is 1.5,AUC = 0.839,P = 0.000 < 0.05,the sensitivity and specific degrees were 0.857 and 0.770,there is statistical significance,and has good diagnostic performance,namely when VIA metastasis lymph node number 1.5 or higher,lymph node metastasis occurred more VIB area;When the diameter of metastatic lymph node in the VIA region was 0.25 cm,AUC=0.731,P=0.001 < 0.05,and the sensitivity and specificity were 0.731 and 0.636,respectively,showing statistical significance and good diagnostic efficacy.That is,when the diameter of metastatic lymph node in the VIA region was ≥0.25 cm,the risk of lymph node metastasis in the VIB region was higher.Conclusion:(1)Carbon nanoparticles can increase the number of lymph nodes detected in VIA region during the operation of low-risk group of papillary thyroid carcinoma,but it has no significant effect on improving the positive rate of lymph node dissection,and the effect of carbon nanoparticles on patients with lymphocytic thyroiditis is limited.(2)In this group,some patients with lymph node metastasis in VIB region did not have VIA region lymph node metastasis,and intraoperative dissection of the VIA region lymph nodes and neglect of evaluation of the lymph nodes in VIB region may result in residual lymph node metastasis in VIB region.(3)Age <45 years old,male,maximum diameter of tumor ≥1cm,capsule invasion,extra-glandular invasion,nodular calcification and lymph node metastasis in the lateral cervical region were significantly correlated with lymph node metastasis in the VIA region.Male,with lymph node metastasis in the lateral cervical region and VIA region were significantly correlated with lymph node metastasis in the VIB region.(4)Age <45 years and males were independent risk factors for lymph node metastasis in the VIA region.Lymph node metastasis with VIA region is an independent risk factor for lymph node metastasis in region VIB.(5)When the number of metastatic lymph nodes in the VIA region is ≥2 and the diameter of the metastasis is ≥0.25 cm,the risk of lymph node metastasis in the VIB region is higher.It is recommended to thoroughly clean the lymph nodes in the VIA region and VIB region. |
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